Skip to main content
SpringerLink
Log in

Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study

  • Basic Science • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

To assess whether vestibulo-ocular reflex (VOR) gain, posturography parameters and related clinical outcomes can improve in OSA patients after 12 months of CPAP treatment, taking into consideration that a certain degree of vestibular dysfunction has been identified in these subjects.

Methods

Vestibular, postural, clinical, and polygraphic parameters were assessed in 32 OSA patients before and after beneficial CPAP treatment by means of video head impulse test (vHIT), static posturography (SP), Dizziness Handicap Inventory (DHI), Epworth Sleepiness Scale (ESS), and Apnea–Hypopnea Index (AHI), respectively, and were compared by means of a “within-subject” ANOVA model and Spearman’s rank correlation.

Results

After the 12-month period of treatment, OSA patients demonstrated a significant reduction in AHI values, in both opened and closed eyes conditions of surface and length as well as in power spectra recorded in low, middle, and high frequency interval. Although a significant improvement was also recorded among DHI and ESS scores, VOR gain increase did not survive to post-hoc corrections. Finally, positive correlations between the differences between pre- and post-treatment AHI, ESS, and PS values were found.

Conclusions

The present work highlighted that postural instability and dizziness-related conditions due to OSA may improve after 12 months of CPAP treatment. Although VOR gain did not demonstrate significant improvement, this study might open future perspectives directed to assessing VOR gain changes after longer periods of CPAP treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AHI:

Apnea–Hypopnea Index

ODI:

Oxygen desaturation index

SaO2 :

Oxygen saturation

lowest SaO2 :

Time spent with SaO2 < 90%

vHIT:

Video Head Impulse Testing

SPT:

Static Posturography Testing

SP:

Stiff platform

FC:

Foam carpet

FFT:

Fast Fourier transform

PS:

Power spectra of body oscillations

DHI:

Italian Dizziness Handicap Inventory

ESS:

Epworth Sleepiness Scale

VOR:

Vestibulo-ocular reflex

References

  1. Kayabasi S, Iriz A, Cayonu M, Cengiz B, Acar A, Boynuegri S, Mujdeci B, Eryilmaz A (2015) Vestibular functions were found to be impaired in patients with moderate-to-severe obstructive sleep apnea. Laryngoscope 125(5):1244–1248. https://doi.org/10.1002/lary.25021

    Article  PubMed  Google Scholar 

  2. Archbold KH, Borghesani PR, Mahurin RK, Kapur VK, Landis CA (2009) Neural activation patterns during working memory tasks and OSA disease severity: preliminary findings. J Clin Sleep Med 5(1):21–27

    PubMed  PubMed Central  Google Scholar 

  3. Nashner LM (1985) Strategies for organization of human posture. In: Igarashi M, Black FO (eds) Vestibular and Visual Control on Posture and Locomotor Equilibrium. Karger, Basel, pp 1–8. https://doi.org/10.1159/000410293

    Chapter  Google Scholar 

  4. Bougard C, Davenne D (2014) Morning/evening differences in somatosensory inputs for postural control. Biomed Res Int 2014:287436. https://doi.org/10.1155/2014/287436

    Article  PubMed  PubMed Central  Google Scholar 

  5. Morad Y, Azaria B, Avni I, Barkana Y, Zadok D, Kohen-Raz R, Barenboim E (2007) Posturography as an indicator of fatigue due to sleep deprivation. Aviat Space Environ Med 78(9):859–863

    PubMed  Google Scholar 

  6. Drummond SP, Brown GG (2001) The effects of total sleep deprivation on cerebral responses to cognitive performance. Neuropsychopharmacology 25(5 Suppl):S68–S73. https://doi.org/10.1016/s0893-133x(01)00325-6

    Article  CAS  PubMed  Google Scholar 

  7. Quarck G, Ventre J, Etard O, Denise P (2006) Total sleep deprivation can increase vestibulo-ocular responses. J Sleep Res 15(4):369–375. https://doi.org/10.1111/j.1365-2869.2006.00550.x

    Article  CAS  PubMed  Google Scholar 

  8. Bougard C, Lepelley MC, Davenne D (2011) The influences of time-of-day and sleep deprivation on postural control. Exp Brain Res 209(1):109–115. https://doi.org/10.1007/s00221-010-2524-8

    Article  PubMed  Google Scholar 

  9. Fabbri M, Martoni M, Esposito MJ, Brighetti G, Natale V (2006) Postural control after a night without sleep. Neuropsychologia 44(12):2520–2525. https://doi.org/10.1016/j.neuropsychologia.2006.03.033

    Article  PubMed  Google Scholar 

  10. Gomez S, Patel M, Berg S, Magnusson M, Johansson R, Fransson PA (2008) Effects of proprioceptive vibratory stimulation on body movement at 24 and 36h of sleep deprivation. Clin Neurophysiol 119(3):617–625. https://doi.org/10.1016/j.clinph.2007.10.058

    Article  CAS  PubMed  Google Scholar 

  11. Gallina S, Dispenza F, Kulamarva G, Riggio F, Speciale R (2010) Obstructive sleep apnoea syndrome (OSAS): effects on the vestibular system. Acta Otorhinolaryngol Ital 30(6):281–284

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Mutlu M, Bayir O, Yuceege MB, Karagoz T, Firat H, Ozdek A, Akin I, Korkmaz H (2015) Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 272(11):3137–3141. https://doi.org/10.1007/s00405-014-3294-x

    Article  PubMed  Google Scholar 

  13. Micarelli A, Liguori C, Viziano A, Izzi F, Placidi F, Alessandrini M (2017) Integrating postural and vestibular dimensions to depict impairment in moderate-to-severe obstructive sleep apnea syndrome patients. J Sleep Res 26(4):487–494. https://doi.org/10.1111/jsr.12516

    Article  PubMed  Google Scholar 

  14. Henderson LA, Fatouleh RH, Lundblad LC, McKenzie DK, Macefield VG (2016) Effects of 12 months continuous positive airway pressure on sympathetic activity related brainstem function and structure in obstructive sleep apnea. Front Neurosci 10:90. https://doi.org/10.3389/fnins.2016.00090

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lundblad LC, Fatouleh RH, McKenzie DK, Macefield VG, Henderson LA (2015) Brain stem activity changes associated with restored sympathetic drive following CPAP treatment in OSA subjects: a longitudinal investigation. J Neurophysiol 114(2):893–901. https://doi.org/10.1152/jn.00092.2015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Diamanti C, Manali E, Ginieri-Coccossis M, Vougas K, Cholidou K, Markozannes E, Bakakos P, Liappas I, Alchanatis M (2013) Depression, physical activity, energy consumption, and quality of life in OSA patients before and after CPAP treatment. Sleep Breath 17(4):1159–1168. https://doi.org/10.1007/s11325-013-0815-6

    Article  CAS  PubMed  Google Scholar 

  17. Fekete K, Boutou AK, Pitsiou G, Chavouzis N, Pataka A, Athanasiou I, Ilonidis G, Kontakiotis T, Argyropoulou P, Kioumis I (2016) Resting energy expenditure in OSAS: the impact of a single CPAP application. Sleep Breath 20(1):121–128. https://doi.org/10.1007/s11325-015-1194-y

    Article  PubMed  Google Scholar 

  18. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of sleep medicine. J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172

    Article  PubMed  PubMed Central  Google Scholar 

  19. Liguori C, Placidi F, Palmieri MG, Izzi F, Ludovisi R, Mercuri NB, Pierantozzi M (2018) Continuous positive airway pressure treatment may improve optic nerve function in obstructive sleep apnea: an electrophysiological study. J Clin Sleep Med 14(6):953–958. https://doi.org/10.5664/jcsm.7158

    Article  PubMed  PubMed Central  Google Scholar 

  20. Micarelli A, Viziano A, Bruno E, Micarelli E, Alessandrini M (2016) Vestibular impairment in multiple chemical sensitivity: component analysis findings. J Vestib Res 26(5–6):459–468. https://doi.org/10.3233/ves-160594

    Article  PubMed  Google Scholar 

  21. Liguori C, Izzi F, Mercuri NB, Romigi A, Cordella A, Tarantino U, Placidi F (2017) Vitamin D status of male OSAS patients improved after long-term CPAP treatment mainly in obese subjects. Sleep Med 29:81–85. https://doi.org/10.1016/j.sleep.2016.08.022

    Article  PubMed  Google Scholar 

  22. Moon M, Chang SO, Kim MB (2017) Diverse clinical and laboratory manifestations of bilateral vestibulopathy. Laryngoscope 127(1):E42–e49. https://doi.org/10.1002/lary.25946

    Article  PubMed  Google Scholar 

  23. Alessandrini M, D’Erme G, Bruno E, Napolitano B, Magrini A (2003) Vestibular compensation: analysis of postural re-arrangement as a control index for unilateral vestibular deficit. Neuroreport 14(7):1075–1079. https://doi.org/10.1097/01.wnr.0000070827.57864.49

    Article  PubMed  Google Scholar 

  24. Bruno E, De Padova A, Napolitano B, Marroni P, Batelli R, Ottaviani F, Alessandrini M (2009) Voice disorders and posturography: variables to define the success of rehabilitative treatment. J Voice 23(1):71–75. https://doi.org/10.1016/j.jvoice.2007.06.002

    Article  PubMed  Google Scholar 

  25. Nola G, Mostardini C, Salvi C, Ercolani AP, Ralli G (2010) Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness. Acta Otorhinolaryngol Ital 30(4):190

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    Article  CAS  PubMed  Google Scholar 

  27. Vignatelli L, Plazzi G, Barbato A, Ferini-Strambi L, Manni R, Pompei F, D'Alessandro R (2003) Italian version of the Epworth sleepiness scale: external validity. Neurol Sci 23(6):295–300. https://doi.org/10.1007/s100720300004

    Article  CAS  PubMed  Google Scholar 

  28. Yoneda S, Tokumasu K (1986) Frequency analysis of body sway in the upright posture. Statistical study in cases of peripheral vestibular disease. Acta Otolaryngol 102(1–2):87–92

    Article  CAS  PubMed  Google Scholar 

  29. Micarelli A, Viziano A, Augimeri I, Micarelli D, Alessandrini M (2017) Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial. Int J Rehabil Res 40:325–332. https://doi.org/10.1097/mrr.0000000000000244

    Article  PubMed  Google Scholar 

  30. Kohen-Raz R, Himmelfarb M, Tzur S, Kohen-Raz A, Shub Y (1996) An initial evaluation of work fatigue and circadian changes as assessed by multiplate posturography. Percept Mot Skills 82(2):547–557. https://doi.org/10.2466/pms.1996.82.2.547

    Article  CAS  PubMed  Google Scholar 

  31. Huynh NT, Prilipko O, Kushida CA, Guilleminault C (2014) Volumetric brain morphometry changes in patients with obstructive sleep apnea syndrome: effects of CPAP treatment and literature review. Front Neurol 5:58. https://doi.org/10.3389/fneur.2014.00058

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wu JC, Gillin JC, Buchsbaum MS, Hershey T, Hazlett E, Sicotte N, Bunney WE Jr (1991) The effect of sleep deprivation on cerebral glucose metabolic rate in normal humans assessed with positron emission tomography. Sleep 14(2):155–162

    CAS  PubMed  Google Scholar 

  33. Cao MT, Sternbach JM, Guilleminault C (2017) Continuous positive airway pressure therapy in obstuctive sleep apnea: benefits and alternatives. Expert Rev Respir Med 11(4):259–272. https://doi.org/10.1080/17476348.2017.1305893

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy

    Marco Alessandrini, Andrea Viziano, Alessia Lanzillotta & Alessandro Micarelli

  2. Department of Systems Medicine, Neuroscience Unit, University of Rome Tor Vergata, Rome, Italy

    Claudio Liguori, Francesca Izzi, Fabio Placidi & Nicola Biagio Mercuri

  3. Emergency Department, ASL RM6, Polo H3, Velletri, Italy

    Donatella Capoccia

  4. ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy

    Alessandro Micarelli

Authors
  1. Marco Alessandrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudio Liguori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Viziano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Izzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Donatella Capoccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessia Lanzillotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fabio Placidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicola Biagio Mercuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alessandro Micarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MA, AM, CL, and AV conceived and designed the experiment; AM, MA, AV, FP, FI, CL, and AL performed the experiment; AM, MA, CL, AV, and NBM analyzed the data; MA, FI, AM, CL, FP, DC, AL, and NBM contributed clinical data/materials/analysis tools; AM, MA, CL, and AV wrote the paper.

Corresponding author

Correspondence to Alessandro Micarelli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alessandrini, M., Liguori, C., Viziano, A. et al. Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study. Sleep Breath 23, 665–672 (2019). https://doi.org/10.1007/s11325-018-1754-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-018-1754-z

Keywords

Search

Navigation